Q:  What allergens do you routinely test for?

A:  We routinely test for the pollens common to this area.  Springtime pollens include local trees and grasses and fall and summer pollens primarily consist of local weeds and ragweed.  We also test for house dust mites, molds, dog and cat dander, and cockroach.

Q:  How do you test for allergies?

A:  There are several ways to test for allergies.  Most often the doctor will order skin tests.  Skin tests provide results in 15-20 minutes and may be done by the prick (scratch) method or by the intradermal method.  In the prick method a drop of an allergen extract is placed on the skin and the skin beneath gently “pricked” with the tip of a sterile lancet.  In the intradermal method a small amount of an allergen extract is placed just beneath the top layer of the skin via a hypodermic needle.  If a reaction is positive a raised red wheal appears on the skin.  Prick tests are usually done on the forearm, but may be done on the back, if necessary.  Intradermal tests are usually done on the upper arms.  On some occasions a blood test (IgE RAST) may be ordered to determine allergies.

Q:  Do you test for food allergies?

A:  Tests for food allergies may be done by the prick method (see above), blood tests (IgE RAST) , or, in some circumstances, by patch testing. 

Q:  How is patch testing different from prick testing? 

A:  Patch testing is different from skin prick testing (which gives a positive response in 15 minutes) in that it is a delayed hypersensitivity response (positive response in about 48 hours). 

Q:  What foods are tested by patch testing?

A: Allergens tested in the Standard Patch Test include:  milk, soy, potato, peanut, rice, oat, wheat, corn, egg, barley, chicken, turkey, lamb, ham, beef, green beans, peas, bananas, apple, carrot.  To be tested for other foods that you suspect and that are not in this list will require significant additional preparation.  Please discuss this with the doctor at the time of your appointment.

Q:  How do allergy shots work?

A:  After a patient completes skin testing, and chooses to begin allergy shots (immunotherapy), the provider will write allergy extract formulations.  Allergy vaccines are compounded for each individual patient based upon his/her skin tests and personal history.  For example, a patient may receive allergy shots for allergens such as tree, grass, and weed pollens, dust mites, molds, and animal dander. By introducing small amounts of the allergen into the body the immune system is stimulated to build an immunity against the allergens.  Slowly, the amount of allergen is increased until an optimal level of immunity is reached.  Allergy symptoms should start to decrease over time and, most likely, you will reach the point where you will have very minimal, or no allergy symptoms, when exposed to an allergen that previously gave you problems because the offending allergens, when inhaled, will no longer cause a severe allergic response.  This is particularly important in cases of insect allergy. 

Q:  How long will it take for my symptoms to improve after starting allergy shots?  How long to I need to stay on allergy shots?

A:  Typically, patients are immunized using a progressive injection series starting with a weak concentration and graduating in concentration until the “full strength” concentration is reached.  The effect of allergy immunotherapy (allergy shots) differs from person to person.  Some patients report symptom improvement during the build up phase of allergy immunotherapy; however most patients report improvement within 6 months to 1 year after achieving maintenance level at the full strength concentration.  Patients usually receive a maintenance dose of vaccine every 2 – 3 weeks for a period of  3 - 5 years.  After 3 - 5 years the patient is usually re-evaluated to determine whether or not allergy shots should be continued  This decision should be discussed with your provider. 

Q:  My skin test was negative, why do I still have “allergy” symptoms?

A:  According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), 1 out of 3 people that have symptoms of nasal congestion and runny nose have no allergies.  These people usually have symptoms of runny nose and nasal congestion that are not seasonal, but persist throughout the entire year.  Because their nasal symptoms are not an allergic response their skins tests are negative.  These people often find, though, that their symptoms may be triggered by irritants such as tobacco smoke, pollution, and strong smells.  The nasal congestion and inflammation, though not caused by allergies, can still be treated.  Nasal corticosteroid sprays and decongestants often provide relief.

Q:  What are Long Acting Beta Agonists (LABAs)?

A: LABA’s are long acting bronchodilators including Serevent (salmeterol) and Foradil (formeterol) which are used in both the treatment of asthma and COPD (Chronic Obstructive Pulmonary Disease).

Q:  What is the nature of the Safety Announcement regarding LABA’s recently issued by the FDA?

A:   LABA’s (Long Acting Beta Agonists) in rare cases have been implicated in a worsening of asthma, and even respiratory death, in a very small number of people.  Overall, however, these medications have been very widely used over a long period of time and have contributed to the success we have in controlling asthma. The FDA announcement recommends that when a LABA is used to control asthma an inhaled corticosteroid should be added to the treatment regimen as well.  Most of our patients who take a LABA use a combination medication such as Advair or Symbicort which combine either salmeterol or formeterol with an inhaled steroid.  The fixed combination enforces compliance.  Some patients, however, take the inhaled steroid and LABA separately. Our policy is to monitor patients who are on LABA’s carefully.  For this reason we generally require routine quarterly visits for this purpose. We have had no hospitalizations in our routinely treated asthma patients in more than a decade.   Patients should not change or discontinue a LABA medication without consulting with their health care provider first.

Q:  How do antihistamines work?
           

A: Antihistamine medications such as Claritin, Clarinex, Allegra, Zyrtec, Xyzal, Benadryl, and nasal sprays such as Astelin, block the action of histamine which is released by cells during allergic reactions.  The release of histamine causes symptoms such as itching, sneezing, and runny nose. Taking an antihistamine medication may prevent or reverse these symptoms. 

Q:  How do nasal steroid sprays work?

A:  Nasal corticosteroid sprays, help reduce inflammation and nasal congestion.  They are usually very effective in relieving nasal congestion and are some of the strongest medications available for nasal symptoms produced by allergies and irritants. 

Q:  Should I use Albuterol every day to help my asthma?

A:  Many patients think it is okay to use Albuterol on a daily basis for their asthma symptoms of wheezing, chest tightness, or shortness of breath.  Albuterol is not intended to be used on a frequent basis,though.  In fact, Albuterol is often called a “rescue inhaler” because it is used to relieve a sudden onset of asthma symptoms.  If you find you need to use Albuterol  more than 2-3 times per week for asthma symptoms then your asthma is not as well controlled as it should be and you should be seen by your provider as soon as possible.

© Richard R. Rosenthal, M.D. 2010. All rights reserved